Medical Laser Blog - Fotona Straight Talk for the Physician

Fotona Lasers: Like a Carpenter’s Hammer

If you go to Fotona’s website the tag line will be: “Highest Performance, Best Made Lasers in the World.”   Seems like a big statement – but I’m here to tell you that I believe it is absolutely true.  The president of Fotona is a man by the name of Matjaz Lukac, PhD.   He earned his PhD at Berkeley.  As I’m sure many of you know, Berkeley is one of the top schools in the country for almost anything.  Getting a PhD in physics from Berkeley is the equivalent of a medical degree from Harvard or being accepted to the NASA astronaut program.  But it doesn’t stop there.  Fotona has more PhD’s, engineers and technicians in their research and development program than any other laser company –period.  

In addition, they have a very large prototype shop.  Their abilities to manufacture “in- house” range from grinding their own optics, doing their own optical coating, building the laser boxes from sheets of metal, to building all of the electronic assemblies….remember again, this is all in-house.  This means they have total quality control!  For this reason, they are able to build prototypes, tweak the design, optimize the manufacture and then put it into production.

The Fotona optics are such that they easily have the most even beam profile of any manufacturer.  In order to achieve this, they had to reinvent the way certain kinds of laser wavelengths were delivered, and then of course patent those ways of delivery.  In order to optimize the amount of energy delivered, they not only designed lasers that self-calibrate, but that this self calibrating takes place within EACH laser pulse - so that the energy delivered is always the energy you have selected on the energy panel.  

If you’ve ever tried to change the light bulb on your car, you find that when you unscrew and take off the bolt that is holding the lens on, a little folded piece of sheet metal falls off.  Now you’ll likely never find that piece again and you’ll be left with a loose screw holding the light lens on your car.  If you look around on your car, you’ll see all sorts of these flimsy pieces.  You NEVER see anything like that on a Fotona.  You’ll always see a proper screw and a proper bolt.  If the bolt does screw into some sort of chassis assembly, it will be a properly tapped piece.  

The reason why Fotona has this tag line is because they build things the way things should be built.  They don’t take cost-cutting measures on quality.  They build the best product that can be built - with the finest engineering in them.  And when that happens, what you get is a medical laser that is highly efficient in terms of its delivery of energy, ranging from the power supply to the laser cavity itself, to the optics that discharge it.  In addition, you get a product that is robust in terms of its ability to simply do its job AND last a long time.

Fotona lasers are like a carpenter’s hammer…they just plain last.  When you’re looking at other lasers or possibly their websites, you look around and find that they don’t tell you much. They don’t give you the important details about their equipment.  Sometimes it’s even hard to figure out exactly which wavelength their laser is.  If you want to learn about our lasers, go to the Fotona website.  Everything is out there for you to read and understand: all of their technology, all of their wavelengths, why they’ve chosen these wavelengths, etc.  The white papers are there for you to read.  It is simply done right.

Fotona Value Added Comes in Low Cost of Ownership

When I was young, I bought a police car thinking I was getting a screamin’ deal on a big muscle car.  I found out later that it’s common knowledge that when you buy a used police car you’re actually buying a new car – one part at a time – because they’re basically used up.  They’ve been rode hard and put up wet…as they used to say in the old west.

The same thing can happen with almost anything you buy. Think about razor blades.  It used to be that you would buy a straight razor and that would last you a very long time – even a lifetime.    Then they came out with “safety razors” and while they practically give you the handle, the blades cost some money.  Another example for the next generation is the inkjet printer.  You could get an inkjet printer that will do just about anything you want for next to nothing, but you have to pay through the nose to get the ink cartridges all the time.

Same thing holds true in laser medicine.  A lot of companies build obsolescence into their hand pieces and other parts.  Some of them even have “shot counters” in them that shut down the machine so that you have to buy more shots.  Fotona doesn’t work that way.  

Fotona has extremely low cost of ownership.  Fotona is a top quality, top tier laser, with all the bells and whistles and with almost no re-occurring cost to the owner.  The costs to the owner are simply normal maintenance, the occasional need to replace a fiber and miscellaneous things like 4x4’s, alcohol, etc – things that any medical office would have on hand anyway.    Cost of ownership is very low.  Our technicians tell us time and time again that we have far fewer breakdowns and far fewer technical problems than other lasers and that when we do have a problem, it is generally easy to fix because Fotona’s lasers are built around a ‘plug ’n play’ modular system so that pieces are swapped out rapidly vs. a lot of difficulties with onsite repairs.

When you’re looking at lasers – don’t just ask about the price of the machine!  While you’ll always find Fotona very competitive in price, remember that in addition, the Fotona laser will be much less expensive in terms of cost of overall ownership.

The Nonsense Vs. Fotona Laser Therapies That Wow

Jotting down my thoughts again from the ASLMS Conference while I sit in 'the thick of it' in the Fotona Booth, I’m just blown away by the nonsense here.  But before I get into the nonsense, let me say that Fotona is a NO-nonsense, high-powered medical laser company – period.  It turns out though, that there are boxes here that, for just maybe $600, you can own and wave the gizmo over your belly and it’ll make the inflammation go away.  There’s another gizmo where you can wave it over your belly and it makes your fat go away…non-invasive, no sign of treatment and no sensation from the machine as well (yeah, right).
 
We need to apply just a tiny bit of common sense here.  The truth is, that photo biology doesn’t work that way.  To have an interaction with tissues, you have to have some kind of effect.  I wish it was that easy.  I have a little belly fat from sitting a bit too much and not exercising quite enough and maybe I should own about 7 of these non-invasive lasers?  If these things really worked, I guess we’d have no problems with obesity in America because you could maybe just create a fiber optic vest that you simply wear all day.  But it turns out, it  doesn’t work that way.
 
There is no magic bullet.  If you want to lose weight, you have to diet and exercise.  If you want to get spot reduction you have to do laser lipo or standard suction lipo or some other similar treatment.  Certainly we can tighten the skin and we can tighten the fat layers with some therapies, but there just isn’t any magic.  So remember, when you’re looking at a system, if it sounds just too good to be true…just like in all other areas of life, it probably is.
 
Again, Fotona has the no-nonsense, high-powered medical lasers that provide real therapies that get the wow result.  The last thing you want is for your patient to be coming back not having achieved the wow result.  If they’re not impressed, they’re not happy, then guess what?  You’re not happy.  You do Fotona therapies and everybody’s going to be happy.
 
Sitting at ASLMS, looking at all of the crazy “snake oil” that’s for sale….don’t be tempted.  It’s just not healthy and it’s certainly not making anybody happy.

Hyperflexible Fotona Laser Systems Are The Real Thing

This week we're heading to the 2010 American Society for Lasers in Medicine (ASLMS) Annual Conference.  I will be interested to look, listen and see what buzz is created this year.  The "Laser 2009" Conference demonstrated that companies are still in pursuit of the next great wavelength.  What companies fail to realize is that it is control of the laser, as well as the wavelength, that brings results.  Shifting the wavelength a few nanometers up or down will result in clinical differences, but not as great a difference as having full control of your laser. 

What the highlights of ASLMS Laser 2009 showed me is that Fotona continues to be well ahead of the curve and we have in our hands, right now, the laser health therapies of the future.

When you are confronted with a new “revolutionary” aesthetic therapy, scrutinize the biophysics behind it.  There are very few new things a laser or other energy device can really do to the skin.  The options are ablate, selective photothermolysis, bulk heat or Frac3®.  When considering what any new “revolutionary” gizmo is really doing, consider how you can configure the hyperflexible Fotona systems to do the same thing.  Mulitple treatment options in every Fotona laser system = VALUE to the laser owner.

Fotona Aesthetic Laser Before and After: No Squinting Necessary

We recently attended the AAD weekend with our booth for Fotona.  The really entertaining part of AAD is walking around and looking at the aesthetic laser before & after pictures.  It’s amazing what people will put up.  It’s very common that you have to squint and twist your head around to decide which photo is the before and which one is the after.  

So many companies are so hooked on trying to create a buzz about a non-invasive, minimally invasive, no-down-time yada-yada-yada kind of procedure that they forget results are important.  People are not interested in a result that requires a computer analysis of your skin in order to decide if your skin is better or not.  They want to look in a mirror from across the room and see if it’s better or not.

So we simply haven’t chased these kinds of treatments.  In our practice, we want “Wow” results.  Wow results don’t happen with no sign of treatment.  Now, maintenance can certainly happen with no sign of treatment.  So the aesthetic procedures that other companies position as a primary therapy for your skin we provide…we have them….and in fact, the ones that we do have been shown in some studies to be better than other things that are out there, but we use them as maintenance, because it’s going to be a rare patient who’ll excited about and stick to a treatment course of once every two weeks for a year before they see results.  Also, when you go through the economics of one big procedure with a few days of redness vs. coming in week after week with time lost for other activities, etc., people will invariably choose one big procedure and then maintenance at some interval like once every six or eight weeks.  They’re happy right away, they get great results, and they’re excited to tell their friends about the great procedure they had.

Don’t be fooled by the one-trick-pony, minimally invasive , no-downtime…can hardly see the difference kind of therapy.  Get a real laser that can do it all.  If the patient comes in and says “yes, this is definitely what I want.  I heard your consult and I don’t want to have any downtime.  I want to have that procedure that tightens my skin slowly over time.”  Fine!  We can provide it!  But don’t let that be the only thing you have in your office because a lot of people will be profoundly disappointed. 

AAD Peddles Snake Oil

Fotona was at the AAD Conference this year, as always, and I had the opportunity to walk around the exhibit floor.  While there are many, many high quality companies, many of the vendors are really peddling products of extremely dubious use.  

For example, supposedly, all you have to do is wave a reddish-colored diode over your abdomen and you will magically lose weight!  (That, according to one company.)  Another company will make bruises go away within 3 minutes to 3 hours with another laser diode device.  It’s an amazing world we live in when magical things can happen that nobody else can reproduce and yet, they can get FDA clearance to sell these devices.  

Here’s where the difference lies.  When you talk with Fotona Lasers, you find there are many things that lasers can do.  There are also things that lasers can do that have very little clinical efficacy, but Fotona sticks with the things that have the “wow” factor.  Even when we CAN do an excellent job of non-invasive, non-ablative skin rejuvenation, we don’t put that in the front.  We say, “you know what? That’s really positioned as an add-on service after you do the “wow” service” OR we explain very carefully to the patient that if they’re willing to show up every four weeks for a year, at the end of the year they can expect to see significant improvement in the texture, tone and the coloration of their skin.  We don’t hype it as the noontime fix-it-all…because that just doesn’t exist!

What a patient wants is a therapy that makes them look better – soon.  They want something that actually works and where you don’t have to have a photographic computer analysis to tell them how much better their skin is.  They want to see it, they want to feel it, and they want other people to comment on it.  And unless your therapy does that, it’s not a real therapy.  So, we sell real therapies, with the softer therapies either carefully consulted, long-term projects for the patient who really understands, and wants to have a completely non-invasive, non-ablative, no-sign-of-treatment therapy, or we position them only as maintenance for bigger aesthetic treatments that they’ve had.

Now, the non-invasive, non-ablative, no-sign-of-treatment therapies that Fotona has have been shown in various published studies to be as good as stuff that’s already out there that’s being sold as first line therapy.  So it’s not that we have a second rate no-sign-of-treatment therapy, we have a FIRST-RATE no-sign-of-treatment therapy, but that’s not how we position it, because it’s just not what patients get excited about or happy about, again, unless it’s a very careful consult.  So think about that.  Fotona…it’s the no B.S. Company.

Laser Technology For Tissue Absorbtion: High or Low, Good or Bad?

Many companies will tout their laser technology regarding the high absorption of their laser into their target tissues, and depending on the application, this can be a very good thing or a very bad thing.  In the case of ablative procedures, extremely high coefficient of absorption into water is clearly a very good thing.  This is fully explained in Fotona’s white paper on ablative procedures.

The short answer here is that a very high coefficient of absorption into water allows for more versatility in your ablative procedures.  You can use a very short pulse duration with this highly absorbed wavelength and get nearly cold or completely cold ablation.  You could also manipulate the pulse duration using a longer pulse duration to get more coagulation - leaving more heat in the tissue, if that is the desired outcome.  On the other hand, laser lipolysis is an area where you really don’t want a highly absorbed wavelength while doing that procedure.  Some companies tout that their wavelength is highly absorbed in the fat layer.  Well, if that’s the case, if they really have a high absorption coefficient, they’re going to have a small volume of tissue that is highly heated.  Now at first glance, this seems like a good idea, but what this really means is that your footprint with each pass is small, so you’re going to require more and more passes through the fat layer in order to get the desired temperature and “fat melting.”

With an optimal mixture of absorption and diffusion into the tissue, you can get a larger volume of tissue to your target temperature.  And it is the target temperature that you desire.  Not too cold, not too hot.  As Goldilocks would say…  “just right.”  It turns out that for laser lipolysis, a lower coefficient of absorption allows for a larger volume of tissue to be heated through diffusion of heat which results in more efficient melting of the fat for fewer passes and more efficient and a faster laser lipolysis procedure.  

So you need to be cautious when listening to sales pitches from sales guys.  It is not simply a matter of  “does this laser have high absorption or low absorption?” The  question is, “what is the application and what are we trying to accomplish?”  If we’re trying to accomplish the warming or heating of a bulk area, you don’t want high absorption.  On the other hand, if you want ablation, very specifically, and you want to have the latitude to manipulate the amount of heat you’re placing in tissue, then you do want very high absorption.  

The other thing you want is a laser that can be fully manipulated.  Having the opportunity to vary the wavelength is difficult.  There are lasers out there that call themselves “tunable lasers.”  The lasers in the aesthetic market that call themselves tunable are actually a fixed wavelength that are varying their pulse-width… something that Fotona has been doing, not by trying to trick you into thinking it’s a variable wavelength, but my simply telling you that we can vary the pulse duration.

So, rather than going for gimmicks, look for the laser that you have the most authority over and look for the company that has perfected the square pulsing, the flat top optics, the variance of it’s pulse durations and the power that will give you spot sizes and speed.  That’s what you’re looking for…not some magical marketing terms like “tunable!”

Turn Bad News into Good News For Your Aesthetic Laser Practice

In my last blog post, I talked about the calls we get at our aesthetic laser practice from people who have seen reports of laser treatments gone bad.  This presents an opportunity for us to contrast that bad news with our good news with Fotona Lasers. 

In order for bad news to be good news for you, you need to have your elevator talk down pat!  Your elevator talk is your clear, concise and understandable discussion, in everyday language, using interesting and understandable analogies about each of the medical or aesthetic procedures you do.  You need to put some time, energy and effort into this and then you need to explain to and rehearse these “elevator talks” with your staff.  

The concept behind an elevator talk is this:  you enter an elevator, encounter a stranger, exchange pleasantries and the stranger says to you “so, what do you do?”  If you can’t explain it in the time it takes a high speed, express elevator to reach the next floor, you can’t explain it to anyone. So get your game on, get your elevator talk ready, and let’s learn how to turn bad news into good news!

Measure the Cost of Cosmetic Laser Ownership the Right Way

What is the cost of ownership of a laser system?  Is it the purchase cost? I don’t think so.  Is it the per-patient cost?  That is part of the answer.  What about maintenance costs?  Well you know what, you get what you pay for.  Recently I had an interesting discussion with the owner of a competitive aesthetic clinic in our town.  He said, I am so glad you are in town.  I literally took a step back and said, “Why is that?”  He had at one point said that his intent was to put us out of business.  In addition, at the beginning we had counseled him that the equipment he was looking at was not likely to get the results they claimed.  So these many years later he is glad we are in town why?  “Because,” he said, “we can’t get the results you get, our cost of operation has been much higher than anticipated and I am going to focus on my core business and send the other stuff to you.”  I replied, “let's have lunch because I am sure we have business for you as well.”

The acquisition cost of our lasers is a bit above the average of the high-end machines.  But our per-patient cost is measured in gauze 4X4’s and alcohol preps, not in per-patient treatments heads or disposable hand pieces.  Fotona quality is legendary.  Our team of laser maintenance engineers is self-employed and work on many brands.  Without exception they tell us we have the fewest problems in the field.  Lasers are machines and so naturally will have issues, but Fotona lasers are built to a higher standard.

For a Medical Laser Company - Wouldn't You Choose Perfection?

Choose Perfection

This is the tag line of the medical laser company, Fotona.  "Choose Perfection."  Further they state: “Best Made Laser Systems in the World.”  I have occasion to speak with laser repair techs all over the US.  They are factory trained on Fotona systems and they tell me that Fotona lasers require less maintenance than any other laser they service.  In fact, one told me Fotona lasers are great but that “I would not want to rely on them for my income as I rarely get calls on them.”

Why is that?  Just back from the Fotona factory in Europe and I can tell you that they live in a culture of excellence.  Every place you turn there is a PhD or Engineer working on an R&D project.  They have grad students (PhD candidates) working under the guidance of the Fotona staff and professors from the local universities using their labs for data collection.  Many areas more closely resemble a university research lab than a manufacturing plant.

Over on the manufacturing side they have state-of-the-art C&C machines.  These are computer-controlled robots that make parts to extremely fine tolerances.  The lasers themselves are not built on an assembly line but rather, are hand-crafted by skilled workers, each taking personal responsibility and more importantly, pride in their product.

So what is my experience as a Fotona owner and user?  Well, I have broken a few fibers over the years.  That was my fault.  I have burned a few protective windows and have replaced flash lamps.  All of these are consumable products.  The handpieces are not disposable - in fact most are made of titanium or stainless steel, not plastic.  Generally we are told, “everything is in spec.”  Of course Fotona lasers are just machines and so they do occasionally have problems, but we are told by our techs that the rate is very low compared to the other companies.

Fotona.  Choose Perfection.